Background
Perioperative anxiety affects most children undergoing surgery and predicts emergence delirium, postoperative pain, and behavioral change. The validated modified Yale Preoperative Anxiety Scale (mYPAS) is scored at only a few discrete timepoints, leaving physiologic status between assessments unmeasured.
Aims
We tested whether continuous wearable heart rate correlates with the mYPAS where scored, and whether heart-rate elevations of undetermined cause occur during intervals without concurrent mYPAS observation.
Methods
Children aged 4–17 undergoing elective surgery wore a wrist biosensor (Empatica EmbracePlus) from holding through induction; the mYPAS was scored at consent, parental separation, and induction. We assessed heart rate–mYPAS concordance and the proportion of heart-rate elevations falling outside ±5 min of any mYPAS timepoint, stratified by premedication.
Results
Of 32 consented children, 15 were analyzable (median age 10 years, nine male, eight premedicated). Induction-window heart rate correlated with induction anxiety (Spearman ρ = 0.55, 95% CI 0.01–0.84, p = 0.034) and rose into induction in 13 of 15 children (median + 10 beats/min, p = 0.022). Of 90 heart-rate elevations among 14 children with reliable timing, 71% fell outside the assessment windows (95% CI 58%–80%); 12 of 14 (86%) had ≥ 1 event outside all assessment windows. This pattern persisted regardless of premedication. Heart rate tracked children’s state self-report (ρ = 0.62, ages ≥ 9) but not trait anxiety; informants agreed modestly.
Conclusions
In this small feasibility cohort, wrist-derived induction-window heart rate was associated with concurrent mYPAS scores. The majority of heart-rate elevations of undetermined cause occurred outside scheduled mYPAS assessment windows. These exploratory findings require confirmation in a larger study incorporating raw physiologic signals, motion measurement, and continuous or event-linked behavioral assessment, which would establish whether continuous physiologic monitoring can complement intermittent behavioral assessment by identifying physiologic events occurring between scheduled anxiety assessments.
Clinical Implications
What Is Already Known?
Pediatric perioperative anxiety is assessed at fixed timepoints with the mYPAS, which cannot capture stress occurring between those assessments.
What New Information This Study Adds?
Continuous wrist heart rate agreed with the mYPAS at the moments it is scored, yet showed that most heart-rate elevations occurred between those scheduled assessments, quantifying the proportion of elevations that occurred outside the scheduled assessment windows.